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Chapter 8 - Drug therapy for dyslipidemia

Terms in this set (14)

Overview of dyslipidemia
Blood lipids include cholesterol, phospholipids, & triglycerides

Blood lipids are transported in plasma by lipoproteins

Each lipoprotein contains cholesterol, phospholipid, & triglyceride

Elevated total cholesterol & LDL cholesterol & reduced HDL cholesterol are major risk factor for CAD

Elevated triglycerides play role in cardiovascular disease
Plasma cholesterol & triglyceride levels
Total serum cholesterol (mg/dL)
Normal or desirable = < 200
Borderline high = 200-239
High = 240 or above

LDL cholesterol (mg/dL)
Optimal = < 100
Borderline high = 130-159
High = 160-189
Very high = 190 or above

HDL cholesterol (mg/dL)
High = more than 60
Protective level = 40-60
Low = < 40

Trigylcerides (mg/dL)
Normal or desirable = < 150
Borderline high = 150-199
Very high = 500 or above
HMG-CoA reductase inhibitors
Atorvastatin (Lipitor) is the prototype

Decrease production of cholesterol, thereby reducing total serum cholesterol, LDL, & triglycerides

HDL remains unchanged or may increase

Undergoes extensive first pass metabolism & food decreases rate of absorption

Statins inhibit enzyme (HMG-CoA reductase) required for hepatic synthesis of cholesterol

Metabolism involves P450 enzyme
Use of Atorvastatin
Used for treatment of hypercholesterolemia & reducing cardiovascular events

Usually well tolerated in older adults; may accumulate in hepatic impairment
Adverse effects of Atorvastatin
nausea
constipation
diarrhea
abd. cramps
HA
skin rash

Contraindications: potentially teratogenic (pregnancy category X)
Bile acid sequestrants
Cholestyramine (Prevalite, Questran) is the prototype

Reduces LDL cholesterol

Has little or no effect on HDL & either no effect or increased effect on triglycerides

Not used alone; used in combination with other products

Binds bile acids in the intestinal lumen, causing them to be excreted in feces without recirculating to the liver
Mechanism of Bile acid sequestrants (Cholestyramine)
Loss of bile acids stimulates hepatic synthesis of more bile acids from cholesterol. As more hepatic cholesterol is used to produce bile acids, more serum cholesterol moves into the liver to replenish the supply, thereby lowering serum cholesterol.
Adverse effects of Bile acid sequestrants (Cholestyramine)
not absorbed systemically; main adverse effect is GI related (abdominal fullness, flatulence, diarrhea, & constipation)

Contraindications: complete biliary obstruction, can bind with vitamin K
Nursing implications of Bile acid sequestrants (Cholestyramine)
May decrease the absorption of many oral medications & vitamins

Do NOT administer with other drugs; to minimize altered absorption

Observe for decreased levels of total serum cholesterol, LDL cholesterol, & triglycerides....and increased HDL cholesterol

Patient teaching: assess levels of vitamins, good dental hygiene is important
Fibrates
Fenofibrate (TriCor) is the prototype

Increase the oxidation of fatty acids in the liver & muscle tissue

MOST effective drug for reducing serum triglycerides

Main indication is for serum triglyceride > 500 mg/dL

Accumulate with renal impairment

May cause hepatotoxicity

Adverse effects: GI discomfort & diarrhea
Nursing implications of Fibrates - Fenofibrate
May enhance effect of anticoagulants

Must give with food

Assess for decrease total serum cholesterol (mainly triglycerides)

Report S&S of adverse effects
Cholesterol absorption inhibitor
Ezetimibe (Zetia) is the prototype

Act in small intestine to inhibit absorption of cholesterol & decrease delivery of intestinal cholesterol to the liver

When used in combination with HMG-CoA reductase inhibitors, works well in reducing total serum cholesterol

Reduces total cholesterol & triglycerides & increases HDL cholesterol

Used together with dietary management

Adverse effects: HA, diarrhea, hypersensitivity reactions
Nursing implications of Cholesterol absorption inhibitor - Ezetimibe
May be administered with or without food
At the same time each day
Assess total cholesterol level
Assess for adverse effects
Miscellaneous dyslipidemic agent
Niacin (nicotinic acid) is prototype

Decreases LDL & increases HDL cholesterol

Inhibits mobilization of free fatty acids from peripheral tissues & raises HDL by reducing lipid transfer of cholesterol

MOST effective drug for increasing the concentration of HDL cholesterol

Adverse effects: high doses required for dyslipidemic effects; skin flushing, pruritus, & gastric irritation
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